Insulin

Medicare Part B (Medical Insurance)

 doesn’t cover these:

  • Insulin (unless use of an insulin pump is medically necessary )
  • Insulin pens
  • Syringes
  • Needles
  • Alcohol swabs
  • Gauze
Your costs in Original Medicare

You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the 

Medicare-Approved Amount

, and the Part B 

deductible [glossary]

 applies). You pay 100% for syringes and needles, unless you have Part D. 

Insulin savings through the Part D Senior Savings Model

Starting January 1, 2021, you may be able to get Medicare drug coverage that offers broad access to many types of insulin for no more than $35 for a month's supply. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets you choose among drug plans that offer insulin at a predictable and affordable cost.

Find a plan that offers this savings on insulin in your state. You can also filter and compare participating plans to help you find the plan that’s right for you. You can join during Open Enrollment (October 15 – December 7, 2020).

Note for people with Extra Help

If you get full Extra Help, your set copayment for insulin is lower than the $35 copayment for a month's supply under the Senior Savings Model. If you get partial Extra Help, you may pay up to a $92 deductible and 15% coinsurance, which may be higher or lower than the $35 copayment under the model. Contact 1-800-MEDICARE if you need help checking the level of Extra Help you get.

note:

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service
Things to know

Part D covers these:

  • Injectable insulin that's not used with an insulin pump
  • Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs

However, if you use an external insulin pump, Part B may cover insulin used with the pump and the pump itself as durable medical equipment (DME). If you live in certain areas of the country, you may have to use specific pump suppliers for Medicare to pay for an insulin pump.

note:

Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover - like vision, hearing, or dental. Contact the plan for more information.

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